Professional Documents
Culture Documents
Supported by Program No. IRT13051 for Changjiang Scholars and Innovative Research Team in University.
a
Resident, State Key Laboratory of Military Stomatology, Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xian, China.
b
Resident, State Key Laboratory of Military Stomatology, Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xian, China.
c
Resident, State Key Laboratory of Military Stomatology, Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xian, China.
d
Professor, State Key Laboratory of Military Stomatology, Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xian, China.
Figure 1. Clinical appearance of pigmented gingiva. Maxillary right canine and rst premolar restored with Ni-Crebased metal ceramic crowns.
Discolored gingival tissues showed gray-black thread-like appearance. A, Buccal view. B, Palatal view.
Figure 2. A, Metal ceramic crowns removed. B, Discolored gingiva resected under local anesthesia.
January 2016
Figure 3. A, Microscopically, pigmentation located mainly in epithelial cells and along basement membrane (small arrows); 225 magnication. B, Desmosomes connecting epithelial cells were missing in some cells, and separated cells can be seen. C, Increased local vessels with thickened vascular walls and
swelling endothelial cells. D, Gingiva showed brosis, degeneration, and local inltration of basophils. Fibrous tissues were scattered with brown particles.
Spectrum 2
O
Ca
c
O
Na
Cl
S
P Ca
2
Atomic, %
61.00
69.63
30.24
25.91
Na
4.85
2.89
0.54
0.24
0.91
0.39
Cl
2.22
0.86
Ca
0.24
0.08
100.00
100.00
Total
10
12
14
16
18
20
keV
Weight, %
DISCUSSION
The occurrence of blue-gray pigmentation in the soft
tissues adjacent to metallic restorations represents a
challenging problem for dentists. Although much effort
has been made, the exact underlying mechanism is still
largely unknown. It is generally accepted that such
pigmentation is caused by mechanical penetration of the
metallic materials.10 Yamada and Sato11 reported the
presence of silver-containing stains in the vicinity of a
gold alloy based crown. The presence of silver, gold,
copper, and palladium in the tissues adjacent to dental
alloys has also been reported by Garhammer et al.12
THE JOURNAL OF PROSTHETIC DENTISTRY
with histopathological microscopy and EDX. Results indicated that the discoloration was not caused by the direct
deposition of the Ni and Cr ions, because the gray-black
gingiva did not contain Ni and Cr.
REFERENCES
A patient with gingival discoloration around the NiCrebased metal ceramic crowns is described. A biopsy
from the pigmented tissues was histopathologically
examined. Large amounts of pigmented deposits were
found along the basement membranes, which is similar to
a previous study of amalgam tattoos.13 When EDX was
used to analyze the elements in the deposited pigments,
C, O, and Na were identied (Fig. 4), but no trace of Ni or
Cr was discovered. This nding contradicts previous reports. It has been reported that metal ions such as Ni3+
and Cr3+ released from cast alloys can alter gingival
broblast behavior, including proliferation and metabolism, and enhance the level of inammatory mediators
such as Interleukin 6 (IL-6), IL-1b, and tumor necrosis
factor-alpha (TNF-a).14 Cytotoxicity tests have also shown
that ions released from cast alloys could result in changes
in DNA, RNA, and protein syntheses, promoting oxidative
DNA damage and ultimately inducing apoptosis.15
Further investigation is needed to clarify whether this
patients discoloration was caused by apoptosis.
SUMMARY
This clinical report describes a patient with gingival
pigmentation near the Ni-Crebased metal ceramic crowns.
A specimen from the pigmented gingiva was examined
Tian et al